Training in Laser Bronchoscopy and Proposals for Credentialling: Problems Encountered During and ArrER Laser Bronchoscopy Courses (Part 5)

The most important data which were obtained from the questionnaire survey are displayed in Table 3. When analyzing these data, it is important to remember that they represent the experience of physicians two years after they attended our laser bronchoscopy courses. The most disconcerting information in these data are the infrequency with which laser bronchoscopy is done by physicians who have attended our courses. For all but six who responded to the questionnaire, the frequency of performing such cases averages not more than one procedure every three months! It is difficult to believe that such procedures are being done as skillfully as would be true, if the physicians doing them had more frequent occasions to hone such skills. The selection of patients, at least by virtue of the location of the lesions (trachea and main stem bronchi, for the most part) seems appropriate. Not evident, however, is whether the lesions were intraluminal in all cases, or whether some patients with largely extrinsic compression of their airways, poor general functional status, or lengthy “bottleneck” benign stenoses might have been included. Interestingly, all patients who had segmental lesions approached for laser resection were done by graduates of our courses who reported total experience <25 cases. Although the overall complication rate seems reasonable, it is higher than has been true in reports from larger series. The true complication rate encountered by our course attendees may be higher than is evident from the responses reported, as it is likely that persons who had done a small number of cases with complications might not have responded to the questionnaire. A higher complication rate is typical when one begins performing new procedures, or when the frequency of performing those procedures remains low.

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